Health reform should make Medicaid and Medicare more interested in preventing chronic diseases in young, expert says

Dr. Wayne Myers

While some rural areas may not have enough doctors (or those who accept Medicaid patients) to treat new patients generated by federal health reform, the key to healthy living is more education, not more physicians, rural medical expert Dr. Wayne Myers opines in The Rural Monitor. As an example, Myers points to Hazard and Perry County, where he once worked. The Appalachian county leads the nation in shortest average life span for women (72.65 years) and is third shortest for men (66.52 years) despite having an abundance of doctors and health facilities. The reason, Myers says, is bad habits that lead to unhealthy lives, something no amount of medical attention can cure.

"In Perry County, as in much of America, medical care is losing to unhealthy behavior," Myers writes. "Clinicians aren’t trained, nor is our clinical system structured, to accomplish changes in long-term cultural behavior, or to respond to the needs of groups of people. Certainly the 15-to-20-minute acute-care visit is a poor situation to try to work with a person on diet, level of activity, his/her addictions. We can’t modify family and social patterns with tools developed to treat strep throat, sprained ankles or breast cancer."

Myers, who headed the federal and Kentucky rural-health offices, said the solution is education at the local level, with "a lot more health educators, community health nurses and nutrition educators" that are trained within the community. Areas with community colleges can build partnerships with schools to receive training, he suggests. His hope is that the Patient Protection and Affordable Care Act will provide the resources and motivation necessary to bring about changes.

As the law generates enrollees, the Center for Medicare and Medicaid Services’ "book of business will shift from old people on Medicare toward younger people on Medicaid," he writes. "When the main business of CMS was Medicare, the rational business strategy was to seek the most economical quality care for those with only a few years to live. As the business shifts toward Medicaid and subsidized private insurance customers, the rational business strategy for CMS shifts toward preventing chronic disease. From an insurer’s point of view, a 70-year-old obese hypertensive diabetic is a self-limited problem. She’ll die soon. A 30-year-old with the same diagnoses will be a very long-term financial drain.  It will be good business for CMS to keep their 'covered lives' healthy."

This, he said, is kind of forward thinking we need to ensure young Americans get healthy. "We need new approaches to keeping people healthy, instead of trying to heal them after they get sick," Myers writes. "Clinicians can’t change the way people live and raise their kids, even if some of the choices the parents make turn out to be pretty dangerous for the kids. These are sensitive life and death issues. We need to tackle them." (Read more)

Book chronicles Hall's 40-year battle for health, against poverty

By Molly Burchett
Kentucky Health News

Eula Hall has been called an angel, dynamite, a force to be reckoned with, and a living legend. She has dedicated her life to combating poverty in Appalachia and providing health care to those in need. Some say that she has done more for health care in Eastern Kentucky than any other single person.

Even at age 86, Hall continues to fight against poverty, providing health care to those who need it. Hall’s story will be told in a new biography, Mud Creek Medicine: The Life of Eula Hall and the Fight for Appalachia, written by Pikeville native Kiran Bhatraju.

Hall grew up in Pike County and moved to the Mud Creek community in adjoining Floyd County at the age of 16. She witnessed the devastating impact of poverty, including lack of health care, and became a staple in the Mud Creek community, someone to whom people would turn when they were sick or hungry.

In 1973, at age 46, Hall opened the doors to The Mud Creek Clinic in Grethel, Ky., a rural community in Floyd County, with a $1,400 donation and the help of two local doctors. The clinic rented space at first, but Hall quickly moved her family out of a nice home in Mud Creek so the home could be converted into a clinic to provide health care regardless of patients' ability to pay.

For 40 years, Hall’s clinic has weathered hard times, reports Jonathan Meador of WKMS in Murray. But, with resiliency and the help of the community, the clinic now operates in five locations and continues its mission: To provide Appalachia’s poorest residents with health care and dental services they can afford.

Hall says things have improved in Appalachia in the last 40 years, but she is still concerned that growing income inequality in America is leaving too many of her patients behind, reports Meador. Appalachians still face numerous economic and health disparities that are deeply rooted in poverty.

"We still have people who don't have enough to meet their needs," Hall told Meador. "These are good people; these are honest people, hard workin' people, when they were able. But you know, they're disadvantaged now, and they just don't have the means to meet their needs and stuff, and somebody has to be concerned; somebody has to look out for 'em."

Bhatraju says that proceeds of his book will go toward funding the clinic. Click here to purchase a copy of the book.

Irvine hospital's Susan Starling wins American Hospital Association's award for leadership in small or rural hospitals

Susan L. Starling, president and CEO of Marcum & Wallace Memorial Hospital in Irvine, is the 2013 winner of the American Hospital Association’s Shirley Ann Munroe Leadership Award.

The award recognizes the accomplishments of small or rural hospital leaders who have improved health care delivery in their communities through innovative and progressive efforts. Starling was recognized "as a widely respected leader who fosters strong collaborative relationships that improve the health care of the rural community," says a press release from the American Hospital Association.

Serving a community of approximately 15,000 that covers several counties for the last 30 years, Starling has forged statewide partnerships, updated the Catholic Health Partners facility, provided leadership in initiatives such as Project HOME (Helpful Opportunities for Medical Care Enhancement), helped to connect uninsured and under-insured patients with preventive services, developed partnerships resulting in the first rural community lung-cancer screening and breast-cancer awareness and screening, and in 2010 provided "groundbreaking direction" for her hospital to be certified as the first Level IV trauma center in Kentucky, the release says.

Starling also received the Kentucky Rural Health Association’s Dan Martin Award for her dedication to rural health care in Kentucky in 2012, according to the release, and was recognized by the AHA's political action committee as its Most Valuable Player for her significant outreach and advocacy efforts.

Ky. Hospital Association defends 'critical access' designation that gives small, rural hospitals a federal financial boost

The Kentucky Hospital Association came out strongly for continued federal support of small, rural hospitals Thursday, objecting to a proposal that the "critical access hospital" designation be based entirely on distance from other hospitals. Kentucky has 29 such hospitals, which get slightly higher Medicare and Medicaid reimbursements in return for limiting their size and services.

Until 2006, states were allowed to make the designation based on a community's health status, poverty rate, rural nature and other factors. So many were designated that they became the majority of critical access hospitals. That is also the case in Kentucky.

The Office of Inspector General of the U.S. Department for Health and Human Services said in August that the government could save up to $1 billion a year if the designation were limited to the original criterion, being at least 35 miles from another acute-care facility, or 15 miles in mountainous areas. KHA's initial repsonse is here.

"The OIG report seeks to eradicate rural health care by shutting down rural hospitals," said Charles Lovell, CEO of Caldwell Medical Center, a critical access hospital in Princeton. "People call us Band-Aid stations," but he could provide a long list of lives saved at his hospital, he said. Other speakers cited hospitals' important role in providing jobs and recruiting doctors for small towns. Cutting the list "would only hurt our communities' physical and economic health," said Susan Starling, CEO of Marcum and Wallace Hospital in Irvine.

Fran Feltner, director of the University of Kentucky Center of Excellence in Rural Health, noted that it was National Rural Health Day and said, "I believe every Kentuckian should have access to the right care at the right time, and close to home."

Critical access hospitals make up only 22 percent of Kentucky hospitals, but maintaining their extra reimbursement would also help the chains that own some of them, because costs of the chain can be allocated to individual hospitals. Here are the critical access hospitals in Kentucky, by county:
Allen: The Medical Center at Scottsville
Breckinridge Memorial Hospital, Hardinsburg
Caldwell County Hospital, Princeton
Carroll County Hospital, Carrollton
Casey County Hospital, Liberty
Cumberland County Hospital, Burkesville
Estill: Marcum and Wallace Hospital, Irvine
Floyd: McDowell Appalachian Regional Hospital; Saint Joseph Martin
Grant: St. Elizabeth Medical Center Grant County, Williamstown
Green: Jane Todd Crawford Hospital, Greensburg
Hart: Caverna Memorial Hospital, Horse Cave
Knox County Hospital, Barbourville
Leslie: Mary Breckinridge Hospital, Hyden
Lincoln: Ephraim McDowell Fort Logan Hospital, Stanford
Livingston Hospital and Healthcare, Salem
Madison: Saint Joseph Berea
Marshall County Hospital, Benton
Mercer: James B. Haggin Memorial Hospital, Harrodsburg
Morgan County Appalachian Regional Hospital, West Liberty
Nicholas County Hospital, Carlisle
Ohio County Hospital, Hartford
Owen: New Horizons Medical Center, Owenton
Russell County Hospital, Russell Springs
Simpson: The Medical Center at Franklin
Trigg County Hospital, Cadiz
Union: Methodist Hospital Union County, Morganfield
Wayne County Hospital, Monticello
Woodford: Bluegrass Community Hospital, Versailles

National Rural Health Day to be held Nov. 21, including webinars on current topics

The third annual National Rural Health Day, which brings awareness to rural health issues and current efforts in addressing these issues, will be observed with events nationwide and special presentations in Sterling Heights, Mich., Nov. 21.

The National Organization of State Offices of Rural Health and all 50 state offices of rural health said in a news release that health concerns of the 60 million rural Americans include: a lack of health care providers; accessibility issues, particularly transportation and technology; and affordability, as the result of higher out-of-pocket costs and other factors.

"Meanwhile, rural hospitals and health systems face declining reimbursement rates and disproportionate funding levels that make it challenging to meet the physical, social and economic needs of their communities," organizers say.

The observance also focuses attention on state rural-health offices, which foster relationships, disseminate information and provide technical assistance that improves access to quality health care for rural citizens, according to the news release.

National Rural Health Day events include several free webinars. Topics, times, and speakers are:

• AgriSafe: Protecting the People Who Feed America (Noon EST) – Natalie Roy, executive director and Carolyn Sheridan, clinical director, AgriSafe Network(Registration: https://www3.gotomeeting.com/register/491563334)
• Rural 101: The Basics of Rural Health (1 p.m. EST) – Kristine Sande, program director, Rural Assistance Center(Registration: https://nosorh.webex.com/nosorh/onstage/g.php?t=a&d=660990830) 
• Population Based Health and Health Promotion in Rural (2 p.m. EST) – Lynda Bergsma, program director, Arizona Center of Rural Health; Caroline Ford, former director, Nevada State Office of Rural Health(Registration: https://nosorh.webex.com/nosorh/onstage/g.php?t=a&d=666479151)
• The Affordable Care Act in Rural America (3 p.m. EST) – Tom Morris, associate administrator; Deepti Loharikar, public health analyst, and Aaron Fischbach, public health analyst, federal Office of Rural Health Policy(Registration: https://nosorh.webex.com/nosorh/onstage/g.php?t=a&d=666426441)
• Resources for Recruitment, Networking, and Telehealth (4 p.m. EST) – Mike Shimmens, executive director, National Rural Recruitment and Retention Network; Rebecca Davis, executive director, National Cooperative of Health Networks Association; Kathy Hsu Wibberly, director, Mid-Atlantic Telehealth Resource Center(Registration: https://nosorh.webex.com/nosorh/onstage/g.php?t=a&d=664434416)

The rural health offices' national organization will have a National Rural Health Day press conference and celebration at the National Press Club in Washington at 10 a.m. EST Nov. 21. To learn more about the observance, visit http://celebratepowerofrural.org. Contacts: Bill Hessert at 814-360-1964, billh@nosorh.org; Teryl Eisinger at 586-850-5257, teryle@nosorh.org.

Information session on state health insurance exchange to be offered at Paducah Thursday, Nov, 7

The Kentucky Health Benefit Exchange will present an information session and allow time for questions about Kentucky's online health insurance exchange, KYnect, Nov. 7 at the West Kentucky Community and Technical College in Paducah from 11 a.m. to 1 p.m.

This event is geared toward health-care providers, administrators, directors, community agencies, coalitions, Kynect navigators, mid-level managers, front-line staff and other health-care workers.

Bill Nold, deputy director of the exchange, will present this program, sponsored by the University of Kentucky Center of Excellence in Rural Health, the Kentucky Office of Rural Health, the Purchase Area Health Education Center and the Western Kentucky Rural Health Network.

The event is free, but pre-registration is required because seating is limited. Contact Alice Combs, Kentucky Office of Rural Health, alice.combs@uky.edu, or call 606-439-3557, ext. 83703.

Fighting prescription drug abuse? Save your spot for 'The Difference Faces of Substance Abuse' conference Jan. 28-29

Early registration is open for the 2014 Different Faces of Substance Abuse Conference, which seeks to build collaborations and partnerships among Kentucky community members to address the state's prescription-drug abuse problem at the local level.

The conference, to be held Jan. 28-29 at the Griffin Gate Marriott in Lexington, will address all aspects of substance abuse and misuse, and provide opportunities for networking and professional development. Continuing education credits are available for alcohol and drug counselors, social workers, licensed professional counselors and marriage and family therapists.

Topics for Jan. 28 include faces and voices of recovery, children of substance abuse, and drug-use trends and updates. Michael Barry, CEO of People Advocating Recovery, will be the keynote speaker and will talk about combating the stigma of substance abuse.

On Jan. 29, Jennifer Havens, epidemiologist for the University of Kentucky's Center on Drug and Alcohol Research, will discuss her research about the effect of prescription painkiller use in Eastern Kentucky, followed by a session during which stories of recovery will be shared. Participants can also attend three of the following nine breakout sessions:

Registering early guarantees participants one spot among the 250 available. If registration is received by Nov. 1, it costs $100 per person; after Nov. 1, if space remains, the fee increases to $150 per person. Click here to register.

The conference is a partnership of UK's Cooperative Extension Service and state drug abuse prevention gaencies, says its website. Part of its mission is to plan and implement an educational conference for community partners combating drug abuse problems to improve strategies for minimizing and preventing drug abuse in Kentucky counties.

Kentucky Health Cooperative partners with UK HealthCare, extending coverage to all 120 Kentucky counties

As a result of an exclusive partnership with UK HealthCare, the Kentucky Health Cooperative, the state's new non-profit insurance carrier, expanded its coverage Wednesday to the University of Kentucky's network of over 1,000 clinicians across Kentucky.

For Kentucky residents who enroll in a Kentucky Health Cooperative insurance plan, the agreement is bringing a statewide network of high-level, accessible clinicians to all 120 Kentucky counties, Janie Miller, chief executive officer of the organization, said in a news release.

The cooperative is Kentucky's non-profit, or Consumer Operated and Oriented Plan under the federal health reform law. The co-op offers coverage to individuals and families and to employees of businesses employing two to 50 full-time equivalent employees, which can be purchased on the state health-benefits exchange, branded as Kynect, directly from the co-op website and from many brokers and agents in Kentucky.

Both Anthem and the co-op offer plans throughout the state, while Humana is offering a limited service area. Since the co-op is a new insurance carrier, forging this type of partnership with UK is an important step; UK HealthCare hass multiple locations across Kentucky, including hospitals, clinics, outreach locations and patient care services, says the release. In addition, it ensures that co-op coverage will be accepted by the more than 1,000 clinicians affiliated with the UK health system.

Part of UK HealthCare's mission is to provide Kentuckians with advanced subspecialty care, while collaborating closely with community providers, says its website. Miller said the co-op's collaboration with UK will significantly benefit both Kentuckians who seek advanced medicine and those who require rural health care, the co-op says in the release.

“We look forward to teaming up with some of the nation’s top clinicians and researchers as well as with community providers dedicated to the delivery of well-integrated health services at the community level,” Miller said. (Read more)

Anthem gift will let Kentucky Homeplace expand diabetes self-management and education project to counties in Western Ky.

Kentucky Homeplace has been awarded a second gift of $150,000 from the Anthem Foundation to continue its diabetes self-management education project in Appalachian Kentucky counties that have high rates of diabetes but lack providers to help address it.

With this gift, Kentucky Homeplace community health workers can continue work to improve diabetes outcomes in Appalachia through a Diabetes Self-Management and Education program, which are designed to help people better manage their diabetes through improved self-testing and lifestyle changes, says a release from the University of Kentucky Center of Excellence in Rural Health.

DIABETES BELT (CDC map)

Sixty-eight of Kentucky's 120 counties are included in the “Diabetes Belt” of the rural Southeast, counties in which 11 percent or more of adults have been diagnosed with having diabetes, compared to the national average of 8.5.

In these areas, about a third of the excess risk of becoming diabetic is associated with risk factors that can be modified, such as sedentary lifestyle and obesity, says the Centers for Disease Control and Prevention.  In Kentucky, the number of certified diabetes educators in these counties is much lower than in other areas of the state, the UK release says.

The first study, in Eastern Kentucky, showed more glucose testing by patients and lower measures of hemoglobin A1c, the key indicator of diabetes. The new grant will let Kentucky Homeplace expand to include parts of Western Kentucky and enroll more than 300 additional participants.

Kentucky Homeplace was originally developed in 1994 by the UK Center for Excellence in Rural Health as a demonstration project. It now gets state funding and has worked for two decades to provide tens of thousands of rural Kentuckians with medical, social and environmental services they might not have had otherwise, says the release.

Federal report says many hospitals wouldn't keep critical-access designation if distance rules were strictly enforced

More than two dozen Kentucky communities still have hospitals because of the critical-access hospital program, in which small, isolated hospitals get higher Medicare and Medicaid reimbursements in return for limiting their size and services. Now federal officials appear to be considering a move that could cost the hospitals money and perhaps put them at risk of closing.

Most of the hospitals would not meet current location requirements if required to re-enroll to get reimbursements from Medicare, and the Centers for Medicare and Medicaid Services could realize substantial savings by revoking certification to some of these hospitals and reimbursing them at lower rates set by prospective payment systems and fee schedules rather than at 101 percent of costs, according to a report by the Department of Health and Human Services.

The agency found that "the program costs the government and Medicare beneficiaries up to a billion dollars a year more than the original parameters of the law allowed," Jenny Gold reports for Kaiser Health News. If forced to re-enroll, 849 of the 1,329 hospitals in the program would not meet the requirements -- having 25 or fewer beds and being at least 35 miles away from another facility (15 miles in mountainous terrain) in communities that would otherwise have limited access to health services.

"Until 2006, states were allowed to waive the distance requirement and designate small hospitals considered 'necessary providers' as critical access hospitals as well, even if they were close to other facilities," Gold reports. "The program grew quickly and now nearly one in four acute care hospitals are getting the extra payments. Congress got rid of the loophole in 2006, but hospitals that already had the exemption were grandfathered." (Read more)

Critical-access hospitals are located in Barbourville, Berea, Burkesville, Cadiz, Carlisle, Carrollton, Franklin, Greensburg, Hardinsburg, Hartford, Harrodsburg, Horse Cave, Irvine, Liberty, Martin, McDowell, Monticello, Morganfield, Owenton, Princeton, Russell Springs, Salem, Scottsville, Stanford, Versailles and Williamstown. For a detailed list, click here.

Smokers, take note: Chinese meditation technique offers hope

In 2010, Kentucky had the second highest rate of adult smokers in the U.S., with 24.8 percent of the adult population -- or 1.1 million adults -- smoking, according to statistics from the Cabinet for Health and Family Services. Only West Virginia, at 26.8 percent, had a higher percentage of adult smokers.

So, what can Kentuckians do to cut the cigarette habit?  A Chinese meditation technique may contain the answer. And the kicker is, smokers don't even need to focus on quitting smoking to be successful.

A study by Texas Tech University and the University of Oregon "looked at the effect of the mindfulness meditation known as Integrative Body-Mind Training on the pathways in the brain related to addiction and self-control, discovered that by practicing the meditation exercise, smokers curtailed their habit by 60 percent. The control group that received a relaxation regimen instead showed no reduction in their smoking," reports Newswise, a research-reporting service.

Yi-Yuan Tang, a co-author and director of Texas Tech’s Neuroimaging Institute, told Newswise, “We found that participants who received IBMT training also experienced a significant decrease in their craving for cigarettes. Because mindfulness meditation promotes personal control and has been shown to positively affect attention and an openness to internal and external experiences, we believe that meditation may be helpful for coping with symptoms of addiction.”

The study group consisted of 27 young-adult smokers who averaged 10 cigarettes a day. Fifteen participants received the meditation training over a two-week period. "After two and four weeks, five of the responding smokers whose smoking had been significantly reduced after IBMT reported that they were continuing to maintain the improvement," Newswise reports.

Researchers wrote that "the apparent ability to enhance self-control and reduce stress could make the practice useful in reducing smoking and craving 'even in those who have no intention to quit smoking'" as well as treating individuals with other addictions," Newswise reports. "The meditation regime, they wrote, 'does not force participants to resist craving or quit smoking; instead it focuses on improving self-control capacity to handle craving and smoking behavior.'” (Read more)

Free medical screenings, dental work for teens and adults available in Mayfield through Tuesday

West Kentuckians in need of health care can get free medical, dental and optical screenings through Tuesday, Aug. 13 at the old Morgan Haugh Clinic building at 220 W. Walnut St. in Mayfield from 9 a.m. to 7 p.m., including Saturday and Sunday.

The screenings are a program of the Delta Regional Authority and the Department of Defense. Anyone is eligible to receive the free services, which do not include emergency or obstetrical treatments. For adults and children age two and up, medical screenings, non-emergency medical treatment, minor lab tests, prescription assistance and optometry exams are available. For adults and children 13 and up, dental exams, extractions and fillings are also available.

Services will be provided by 152 medical personnel from the U.S. Army Reserve and the Army National Guard. Other current clinic sites are in Blytheville, Ark., Hayti, Mo., and Dyersburg, Tenn. Earlier clinics were held in Martin, Tenn., Helena-West Helena, Ark., and four communities in western Mississippi.

Nominees sought for award honoring lifetime in rural health

The Kentucky Rural Health Association seeks nominations for an award honoring a lifetime contribution to rural health in Kentucky, named for Dr. Dan Martin of the Trover Foundation in Madisonville. A nominee's contributions might be in areas of direct patient care, health professions education, health administration, health promotion or public advocacy. To nominate someone, please complete the form, available here and e-mail it to Linda Asher at lmashe2@uky.edu; or to the Office of Rural and Community Health, K320 Kentucky Clinic, Lexington, KY 40536-0284; or fax it to (859)323-1043.

Community-based solutions to childhood obesity show signs of progress elsewhere; will Kentucky pick up on them?

By Molly Burchett
Kentucky Health News

For decades, researchers reported with alarm the increasing trend of overweight children in America, with one in three kids on the way to developing Type 2 diabetes. Across the country, action has been taken to address this problematic trend, and now some preliminary, scattered results indicate that obesity rates have plateaued or dropped in some areas. Is Kentucky part of this success, and if not, will it learn from it?

The first set of positive signs came last year, with falling child obesity rates in New York City and Philadelphia, reports Lydia DePillis of The Washington Post. And, a recent Robert Wood Johnson Foundation brief shows similar progress in states with a large rural population as well:

• Mississippi posted a decrease from 43.9 percent of kids being overweight and obese in 2005 to 40.9 percent in 2011, three years after passage of the Mississippi Healthy Students Act. 
• In North Carolina, Vance and Granville counties saw significant declines after implementing healthy living programs based on the Centers for Disease Control’s community guide.
• Kids in Kearney, Neb., in grades one through five saw a 13.5 percent decline in obesity rates between 2005 and 2011.
• West Virginia fifth graders posted a 8.6 reduction in obesity rates over a six-year period.

Overall, progress was made through community-based solutions, including changes to make healthy foods available in schools while eliminating fried foods and working to integrate physical activity into people's daily lives while educating them about the importance of doing that, says the brief.

Kentucky, which suffers from one of the highest childhood obesity rates in the country, could learn from these successful programs. The state ties Mississippi for the highest percentage of youth in grades 9 to 12 that are obese (18 percent) and has the third highest percentage of children ages 10 to 17 who are obese (21 percent), compared to 16.4 percent nationally, says a report by Kentucky's Task Force on Childhood Obesity.

The Kentucky General Assembly has not enacted legislation regarding healthy eating and physical activity like many other states, notes a National Conference of State Legislatures report, but established a task force that made various recommendations to the legislature in September for strategies that address the problem of childhood obesity and that encourage better nutrition and increased physical activity among Kentucky children.

Some of the task force's recommendations include: requiring schools to improve nutritional content of school food, including promoting the use of school gardens, adopting a statewide standard for physical activity initiatives and nutrition education in schools and encouraging physical activity through a coordinated school health program. To view that report, click here.

Kentucky has no requirements for physical activity in schools. About 65 percent of Kentucky's youth did not attend physical-education classes in 2010, and 80 percent did not attend such classes five days per week, says a 2011 Center for Disease Control and Prevention survey.

However, the state does have several programs to promote physical activity or healthy eating. They includes the Farm to School program, which has been adopted by 1,243 schools and 174 school districts and is a collaborative effort between federal and state agencies to bring local agricultural products to schools and to educate students about local food production, says the report.

Using the success of other state programs and existing Kentucky programs as a guide, Kentuckians and "the members of the Task Force on Childhood Obesity are encouraged to continue their advocacy efforts to address Kentucky’s health crisis in ways that have the greatest likelihood of preventing and reversing chronic diseases associated with childhood obesity," says the report.

Ky. Rural Health Association seeks nominations by Aug. 20 for annual award honoring health service to rural Kentuckians

The Kentucky Rural Health Association is seeking nominations for this year's recipient of the Dan Martin Award, an annual honor for an individual who has provided many years of service to rural Kentuckians through direct patient care, health professions education, health administration, health promotion or public advocacy.

This award is named for its first recipient, in 2003, Dr. Dan Martin of the Trover Foundation in Madisonville. Susan Starling, CEO of Marcum and Wallace Memorial Hospital in Irvine, received the award last year, honoring her dedication and compassionate work for rural health in Kentucky.

Nominations will be received until Aug. 20. The award will be presented at the KRHA Annual Conference Sept. 26-27 in Bowling Green. To nominate someone, please complete this form and e-mail to lmashe2@uky.edu.

Family physicians group objects to cuts to primary-care physician training programs; cites doctor shortage, which is worse in Ky.

Facing an already-existing shortage of primary care in the country and state, the American Academy of Family Physicians sent a letter to U.S. Rep. Harold Rogers, R-Ky., chairman of the House Appropriations Committee, saying the committee's 2014 funding allocations could damage the nation's primary-care infrastructure by cutting primary-care physician training and research programs.

In the June 18 letter, AAFP Board Chair Glen Stream wrote, "We are concerned that the House-proposed allocation will be inadequate to make the necessary investment in vital primary care research and physician workforce training." The proposed allocation would reduce funding for the only federal program that provides funds specifically to academic departments and programs that increase the number of primary-care health professionals, says an AAFP release.

There are not enough primary-care physicians being trained to meet the demand for services, and a recent study shows only a fourth of newly educated doctors actually go into this field. Even worse for Kentucky, which faces a critical doctor shortage amid Medicaid expansion, less than 5 percent go on to practice in rural areas, says a study by researchers at the George Washington University School of Public Health and Health Services. The study's lead author wrote, "If residency programs do not ramp up the training of these physicians the shortage in primary care, especially in remote areas, will get worse."

How can Kentucky meet the critical demand for new doctors when Congress has proposed to make additional cuts to training programs?  Kentucky needed to increase its number of doctors and other medical professionals even before the state decided expand Medicaid, says a recent review by Deloitte Consulting.  The review found that the state needs 3,790 additional physicians, including primary-care doctors and specialists, and the doctor shortage is worse among rural communities.

Eastern Kentucky reluctant to accept HPV vaccination that helps prevent cervical, mouth and throat cancers

By Molly Burchett
Kentucky Health News

New research indicates that HPV, the sexually transmitted human papilloma virus, is now the leading cause of mouth and throat cancers in the United States, ranking above both alcohol use and smoking. This problem has a solution, since some cancers caused by HPV can be easily prevented by vaccination, but many Kentucky women are stiff-arming the solution as researchers found they "literally could not give the vaccine away to young women" in Eastern Kentucky.

In Kentucky, vaccination rates remain low, particularly in the east, where the percentage of women who die from cervical cancer is significantly greater than in the rest of state or the nation, notes Tom Collins in a recent Lexington Herald-Leader article. Collins is the associate director of the University of Kentucky's Rural Cancer Prevention Center, which initiated a project to explore the acceptance of the HPV vaccine.

Read more here: http://www.kentucky.com/2013/06/30/2698240/rural-kentucky-slow-to-embrace.html#storylink=cpy

Since 2000, scientists have known that certain strains of HPV are responsible for nearly all cervical cancer in women, and newer studies link HPV to head and neck cancer for many men too. This year, about 14,000 people in the United States will be diagnosed with oropharyngeal cancer, most of them will be young, between 40 and 50 years old and 75 percent will be male, says a Newswise article. A decade ago, patients with head and neck cancer were smokers or drinkers, but now 80 percent of the cancers are caused by HPV.

About half of all Americans will become infected with HPV at least once their lifetime and it's difficult to recognize the symptoms of the virus, making vaccination even more important. The federal Centers for Disease Control and Prevention now recommends that boys and girls both be vaccinated against HPV between the ages of 11 and 12 and up to the age of 26, says Collins.

Collins writes that Eastern Kentucky is slow to accept the vaccine, even when promoted at community events such as hog roasts. Despite the initial reluctance, "Researchers at the center hope that if a community is engaged in the process and allowed to direct the delivery of the necessary change, outcomes can be achieved that will lead to a healthier population," he Collins.

And, there's still hope. The national prevalence of infection in young women has declined by more than half since the introduction of the HPV vaccine, despite low vaccine usage, says recent findings by the CDC. This decline occurred even though only a third of eligible patients received the vaccine, so imagine the benefits afforded to Kentuckians with efforts to improve vaccination acceptance and usage.

Doctor shortage news: Residencies are filling the pond with primary care doctors, but U.S. and Ky. need an ocean of them

Despite a critical shortage of primary care in the country, only 25 percent of newly educated doctors go into this field, and even worse for the mostly-rural Kentucky, less than 5 percent go on to practice in rural areas, says a study by researchers at the George Washington University School of Public Health and Health Services (SPHHS).

The report, which was just released in the “Published Ahead-of-Print” section in Academic Medicine,  suggests that not only are we facing a primary care shortage, but also that the problem is not likely to be solved soon. There's been a lot of talk about the need to get primary care doctors to practice in Kentucky, specifically in the state's rural areas, without mention of the underlying issue that the study makes clear: there are not even close to enough doctors being trained as primary care physicians in the first place.

In addition to finding that just 4.8 percent of the graduate medical education system practiced in rural areas, 198 institutions (26 percent) produced no rural physicians and 283 institutions (37 percent) produced no Federally Qualified Health Center or Rural Health Clinic physicians, which were created to enhance the provision of primary care services in underserved communities.

“If residency programs do not ramp up the training of these physicians the shortage in primary care, especially in remote areas, will get worse,” said lead study author Dr. Candice Chen, a professor at SPHHS. “The study’s findings raise questions about whether federally funded graduate medical education institutions are meeting the nation’s need for more primary care physicians.”

Currently, the U.S. is producing primary care physicians at rates that are “abysmally low” and unless changes are made to the system, the nation will have an even greater shortfall of primary care doctors just as the Affordable Care Act ramps up demand for these services, said Chen in a Newswise release. And in Kentucky, the additional need for primary care doctors as a result Medicaid expansion is piled onto the heap of issues.

The study's authors said policymakers should take a hard look at the skewed incentives and other factors that have led to the current primary care crisis and develop a more accountable graduate medical education system. It is critical to find a better balance in medical specialties and more primary care physicians to build an effective, affordable health system.

Floyd County newspaper editor calls on readers to make lifestyle changes to address area's diabetes health crisis

The editor of an Eastern Kentucky newspaper has joined an advocacy group's call for residents in his county to make simple, healthy lifestyle changes, serving as an example of how local newspapers and community members can engage the public to confront poor health status of the area, which is often put on the back-burner despite alarming warning signs.

Recently, the Tri-County Diabetes Partnership declared the rate of diabetes in Floyd, Johnson and Magoffin counties (map) "a crisis of epidemic proportions." The rate in 2002-10, the latest available, was 14 percent.

If the federal Centers for Disease Control and Prevention "saw a similar increase in any other illness, they would probably declare a national emergency,” said J.D. Miller, vice president of medical affairs for Appalachian Regional Healthcare, who chaired the meeting.

The group's statement was an appropriate response to direct public's attention to the imperative of addressing the area's skyrocketing rate of the disease, Ralph Davis of The Floyd County Times wrote in an editorial.

Diabetes will remain a crisis unless we do something about it, said Davis, and "if you have been waiting for a crisis before making healthy lifestyle changes, we’ve got one for you. In fact, we have several," Davis said.

The Central Appalachian region suffers from disproportionate rates of diabetes, cancer and heart disease, and Floyd, Magoffin and Johnson counties have much higher rates of obesity than state and national averages, Davis notes. Floyd County ranks last among the state’s 120 counties in overall health measures, and Johnson and Magoffin counties are ranked 108th and 104th, respectively.

To do something about this problem, Davis calls for concentrated attention by health care providers and government officials, but the problem won't be solved without action from the community and individuals, he says. Simple, healthy lifestyle changes are needed.

"It’s going to require the conscious decision by everyone in the region to do what they can to improve their diet and exercise habits, and to encourage their friends and family to do the same," said Davis.

Calls like Davis's are needed even more in most of the counties that surround the three counties, based on data from the CDC's Behavioral Risk Surveillance System. The counties in dark blue had rates above 14 percent; the highest was Greenup, at 17 percent.

Rural cancer survivors are less healthy than urban counterparts; 25 percent of rural cancer survivors smoke

A quarter of rural cancer survivors smoke.

Cancer survivors from rural areas live less healthier lives than survivors from urban areas. That's the diagnosis of a study by the Wake Forest Baptist Medical Center in Winston-Salem, N.C., which asked a random sample of rural and urban survivors their body weight, and if they smoked, drank alcohol, and exercised.

The study found that 25 percent of rural cancer survivors smoked, compared to 16 percent from urban areas. It didn't have state-by-state figures, but Kentucky has high rates of both cancer and smoking.

Fifty-one percent of rural survivors didn't participate in any physical activities at all, compared to 39 percent for urban survivors, and 66 percent of rural survivors were obese, while 63 percent of urban ones were. Fewer rural survivors drank alcohol, a difference of 46 percent to 59 percent, and 18 percent of them were more likely to be unemployed because of health reasons, compared to 11 percent for urban survivors.

"Rural cancer survivors may not be receiving messages from their health-care providers about how important quitting smoking and being physical active are after cancer," said Kathryn E. Weaver, assistant professor of social sciences and health policy at Wake Forest Baptist. "It is concerning that we found higher rates of health-compromising behaviors among rural survivors, when we know cancer survivors who smoke, are overweight, or are inactive are at higher risk for poor outcomes, including cancer recurrence and second cancers." (Read more)